[Remote] Claim Examiner - Life

Note: The job is a remote job and is open to candidates in USA. MetLife is one of the world’s leading financial services companies, providing insurance and asset management to individual and institutional customers. The Claim Examiner - Life is responsible for evaluating and processing Federal Employees’ Group Life Insurance claims, requiring strong analytical skills and excellent customer service to navigate complex situations with professionalism and empathy.

Responsibilities

• Obtain and verify all missing information required to evaluate FEGLI life insurance claims
• Interpret policy provisions and manually adjudicate claims within a payment authority up to $400,000
• Review claims to determine whether referral to a Complex Case Manager or Claims Quality Specialist is required
• Actively follow up on open claims and ensure timely resolution
• Maintain accuracy and compliance with production and quality standards
• Respond to written inquiries from policyholders, beneficiaries, attorneys, and families
• Provide clear guidance on claim procedures and resolve issues promptly
• Handle outbound calls related to claim servicing and support customer escalations from Customer Service Associates
• Research claim issues submitted through telephone referrals and provide timely responses
• Work closely with administrative staff to clarify plan provisions and resolve claim discrepancies
• Maintain strong rapport with internal and external customers through ownership, professionalism, and service-oriented communication
• Coach new Life Case Manager Specialists on procedures and workflow
• Provide UAT (User Acceptance Testing) support for system enhancements
• Document and update all claim activity using PowerBuilder, Livelink, EDCS, Accurint, Excel, Microsoft Word, and internal tracking systems
• Initiate investigations using internal and external resources (e.g., autopsy reports, toxicology, accident reports, medical records, missing beneficiary searches, homicide investigations)
• Stay current on FEGLI procedures through Livelink and required training

Skills

• Strong analytical, organizational, and decision-making skills
• Excellent written and verbal communication skills with a customer-focused approach
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in Microsoft Word and Excel; strong data entry skills required
• Ability to handle sensitive situations with empathy, patience, and professionalism
• Willingness to work overtime, including weekends, as needed
• College degree or equivalent relevant experience
• Prior life insurance or claims experience highly desirable

Benefits

• Comprehensive health plan that includes medical/prescription drug and vision
• Dental insurance
• No-cost short- and long-term disability
• Company-paid life insurance
• Legal services
• A retirement pension funded entirely by MetLife
• 401(k) with employer matching
• Group discounts on voluntary insurance products including auto and home
• Pet
• Critical illness
• Hospital indemnity
• Accident insurance
• Employee Assistance Program (EAP)
• Digital mental health programs
• Parental leave
• Paid time off
• Paid holidays
• Volunteer time off
• Tuition assistance

Company Overview